What are the responsibilities and job description for the Pharmacy Technician Billing and Insurance Specialist - Retail position at Carle Health?
Position Summary:
The Pharmacy Technician Billing and Insurance Specialist is responsible for processing prescriptions for insurance prior authorizations (PA), coordinating follow-up for denials, reviewing manufacturer funding and assistance as needed, and processing 340B eligible scripts for qualifying patients.
Qualifications:
EDUCATIONAL REQUIREMENTS
None Required
CERTIFICATION & LICENSURE REQUIREMENTS
Pharmacy Technician License Illinois within 60 days and Certified Pharmacy Technician (PTCB) For pharmacy technicians licensed after December 31, 2007. Exempt: Anyone enrolled in a first professional degree program in pharmacy and designated a �student pharmacist� by IDFPR. within 2 years or Certified Pharmacy Technician (NHA) For pharmacy technicians licensed after December 31, 2007. Exempt: Anyone enrolled in a first professional degree program in pharmacy and designated a �student pharmacist� by IDFPR. within 2 years.
EXPERIENCE REQUIREMENTS
Minimum one year pharmacy tech experience, preferable retail pharmacy
SKILLS AND KNOWLEDGE
Strong verbal and written communication skills. Computer data entry skills. Epic competency preferred, but not required. Demonstrated ability to organize and prioritize work and possess attention to detail. Ability and willingness to work in a clinical environment and closely with nurses and physicians. Demonstrated ability to working independently. Must be able to apply critical thinking skills related to insurance pre-authorization submissions and denial follow-up.
Essential Functions:
- Analyzes information required to complete pre-authorizations with insurance carriers and governmental payors.
- Utilizes third party payer/insurance portals to process PA submissions; has a detailed knowledge of insurance providers, their portals and their expectations for authorization approval.
- Cross-trains to support additional pharmacy office, prescription processing, filling, and scheduling functions as deemed necessary for optimal business operations.
- Assists in supporting all Carle retail pharmacy sites with prior authorization and insurance navigation needs.
- Records accurate and thorough documentation on patients' charts to keep all members of patients' care teams informed on status of PAs.
- Coordinates any denial follow-up, as indicated.
- Performs and records various quality control activities and reports outcomes to the pharmacists and/or manager/supervisor.
- Maintain 340B billing protocols and compliance for qualifying patients.
- Advocates for patients/providers by processing PA's in a time sensitive manner and collaborating, as indicated with physicians and nurses, to accurately secure clinical information to support the PA submission.
- Work on behalf of our patients to ensure they are receiving their prescriptions in a timely manner.
- Collaborate internally with ambulatory departments to identify process improvement opportunities and support department initiatives
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.
Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.